Emerging Trends in Clinical Research With Implications for Population Health and Health Policy

Abstract

Significant advances in clinical medicine that have broader societal relevance may be less accessible to population health researchers and policymakers because of increased specialization within fields. We describe important recent clinical advances and discuss their broader societal impact. These advances include more expansive strategies for disease prevention, the rise of precision medicine, applications of human microbiome research, and new and highly successful treatments for hepatitis C infection. These recent developments in clinical research raise important issues surrounding health care costs and equitable resource allocation that necessitate an ongoing dialogue among the fields of clinical medicine, population health, and health policy. Context Developments in clinical medicine have important implications for population health, and there is a need for interdisciplinary engagement among clinical medicine, the social sciences, and public health research. The aim of this article is to help bridge the divide between these fields by exploring major recent advances in clinical medicine that have important implications for population health. Methods We reviewed the most cited articles published from 2010 to 2015 in 5 high‐impact clinical journals and selected 5 randomized controlled trials and 2 related clinical practice guidelines that are broadly relevant to population health and policy. Findings We discuss the following themes: (1) expanding indications for drug therapy and the inherent medicalization of the population as highlighted by studies and clinical guidelines supporting lower blood pressure targets or widespread statin use; (2) the tension in nutritional research between quantifying the impact of isolated nutrients and studying specific foods and dietary patterns, for example, the role of the Mediterranean diet in the primary prevention of cardiovascular disease; (3) the issue of high medication costs and the challenge of providing equitable access raised by the development of new and effective treatments for hepatitis C infection; (4) emerging clinical applications of research on the human microbiome as illustrated by fecal transplant to treat Clostridium difficile infections; and (5) the promise and limitations of precision medicine as demonstrated by the rise of novel targeted therapies in oncology. Conclusions These developments in clinical science hold promise for improving individual and population health and raise important questions about resource allocation, the role of prevention, and health disparities.

Identifying subgroups of high-need, high-cost, chronically ill patients in primary care: A latent class analysis

“…First, Shadmi [51] suggests broadening the understanding and measurement of multimorbidity by including a large variety of health and health-related aspects (e.g., social, cultural, and economic background of populations) that correlate with multimorbidity. In addition, corresponding to our finding that current segmentation often lacks inclusion of relevant demographic and socioeconomic characteristics, the study by Chin-Yee, Subramanian [52] and Khoury, Iademarco [53] also argued that adding environmental and social characteristics (a rather "population perspective") to the genetic profiling in precision medicine can be of added value to public health.…”

Governing Personalized Health: A Scoping Review

“…On the one hand, genetic testing provides new possibilities for preventative medicine, such as stillbirth prevention (Ker, 2018). On the other, the predictive power (Bourret et al, 2011;Juengst et al, 2012) of precision medicine might re-enforce health inequalities rather than decreasing them (Khoury and Galea, 2016;Chin-Yee et al, 2018). The last point is particularly relevant since it is very unlikely that "personalized" medicine with individually designed plans for prevention and treatments becoming reality in the near future.…”

Reducing the Clinical Medicine and Population Health Divide

“…I n the June issue of The Milbank Quarterly , Chin‐Yee and colleagues discuss 5 recent trends in the published medical literature—disease prevention strategies, the rise of precision medicine, applications of human microbiome research, and new treatments for hepatitis C virus—that may have implications for population health. In doing so, the article illustrates that what is traditionally understood to be the domain of clinical medicine is not clearly different from the concerns of public health.…”